中国普外基础与临床杂志

中国普外基础与临床杂志

肝细胞肝癌在钆塞酸二钠增强 MRI 中肝胆期信号表现与预后的关系

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目的 研究肝细胞肝癌(简称肝癌)在钆塞酸二钠(Gd-EOB-DTPA)增强 MRI 中肝胆期信号表现与预后的关系。 方法 回顾性分析符合纳入标准的重庆医科大学附属第一医院 2014 年 1 月至 2017 年 1 月期间行手术切除并经病理学检查证实为肝癌患者的临床病理资料,根据其在 Gd-EOB-DTPA 增强 MRI 中肝胆期的信号表现分为均匀低信号组(简称低信号组)和不均匀高信号组(简称高信号组),比较 2 组间患者的无瘤生存时间及其影响因素。 结果 本研究共纳入 77 例肝癌患者,其中低信号组 45 例,高信号组 32 例。低信号组和高信号组间患者的年龄、性别、病因、肝功能、甲胎蛋白、分化程度、Child 分级、病灶直径、病灶边界及病灶数目比较差异均无统计学意义(P>0.05),但高信号组分期更晚(P=0.001)。低信号组和高信号组无瘤生存时间分别为(17.0±9.8)个月和(12.4±10.4)个月,Kaplan-Meier 生存曲线结果显示,低信号组的无瘤生存时间明显优于高信号组(P=0.020)。单因素分析后发现,除肝胆期信号外,其他混杂因素对肝癌患者的无瘤生存时间均无影响(P>0.05),进一步将临床上认为可能影响肝癌患者预后的肝胆期信号、BCLC 分期及分化程度纳入 Cox 比例风险回归模型后发现,不均匀高信号仍是影响肝癌患者无瘤生存时间的危险因素(P=0.047)。 结论 肝癌在 Gd-EOB-DTPA 增强 MRI 中肝胆期信号的表现与预后有关,不均匀高信号可能预示着更低的无瘤生存率。

Objective To clarify relationship between signal heterogeneity on hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI and prognosis of hepatocellular carcinoma (HCC). Methods From January 2014 to January 2017 in the First Affiliated Hospital of Chongqing Medical University, a total of 77 patients with the pathologically proved HCC underwent Gd-EOB-DTPA-enhanced MRI prior to surgery were included in this study. On the basis of the signal heterogeneity in the hepatobiliary phase, the included patients were designed to homogeneous hypointensity group and heterogeneous hyperintensity group. The disease-free survival time were compared between the 2 groups and it’s influencing factors were analyzed. Results Seventy-seven patients with HCC were included, including 45 cases of homogeneous hypointensity and 32 cases of heterogeneous hyperintensity. There were no significant differences in the age, gender, etiology, liver function, alpha-fetoprotein, differentiated degree, Child-Pugh grade, lesion diameter, lesion border, and number of lesions between the 2 groups (P>0.05). However, the HCC patients with heterogeneous hyperintensity had a later BCLC staging (P=0.001). The disease-free survival time of the patients with homogeneous hypointensity and heterogeneous hyperintensity was (17.0±9.8) months and (12.4±10.4)months, respectively. The Kaplan-Meier survival curve showed that the disease-free survival time in the patients with homogeneous hypointensity was significantly better than that in the patients with heterogeneous hyperintensity (P=0.020). The results of univariate analysis showed that the other confounding factors had no effect on the disease-free survival time of patients with hepatocellular carcinoma (P>0.05) except for the signal of hepatobiliary phase (P<0.05). Furthermore, the hepatobiliary phase signal, BCLC stage, and degree of differentiation, which might be clinically considered as potentially influencing for the prognosis of patients with HCC, were included in the Cox multivariate proportional hazard regression model and found that the heterogeneous hyperintensity was still the risk factor of the disease-free survival rate in patients with HCC (P=0.047). Conclusion Signal heterogeneity on hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is related to prognosis of patients with HCC, heterogeneous hyperintensity may indicate a lower disease-free survival rate.

关键词: 肝细胞肝癌; 钆塞酸二钠; 磁共振成像; 预后

Key words: hepatocelluar carcinoma; gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid; magnetic resonance imaging; prognosis

引用本文: 杨联, 张超超, 李德卫, 毛芸. 肝细胞肝癌在钆塞酸二钠增强 MRI 中肝胆期信号表现与预后的关系. 中国普外基础与临床杂志, 2018, 25(6): 708-713. doi: 10.7507/1007-9424.201711069 复制

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1. World Health Organization (WHO). Global battle against cancer won’t be won with treatment alone-effective prevention measures urgently needed to prevent cancer crisis. Cent Eur J Public Health, 2014, 22(1): 23, 28.
2. McGlynn KA, London WT. The global epidemiology of hepatocellular carcinoma: present and future. Clin Liver Dis, 2011, 15(2): 223-243.
3. Llovet JM, Bruix J. Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol, 2008, 48 Suppl 1: S20-S37.
4. Yuen MF, Cheng CC, Lauder IJ, et al. Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience. Hepatology, 2000, 31(2): 330-335.
5. Chalasani N, Said A, Ness R, et al. Screening for hepatocellular carcinoma in patients with cirrhosis in the United States: results of a national survey. Am J Gastroenterol, 1999, 94(8): 2224-2229.
6. Vogl TJ, Kümmel S, Hammerstingl R, et al. Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology, 1996, 200(1): 59-67.
7. Choi JW, Lee JM, Kim SJ, et al. Hepatocellular carcinoma: imaging patterns on gadoxetic acid-enhanced MR images and their value as an imaging biomarker. Radiology, 2013, 267(3): 776-786.
8. Kitao A, Matsui O, Yoneda N, et al. Hypervascular hepatocellular carcinoma: correlation between biologic features and signal intensity on gadoxetic acid-enhanced MR images. Radiology, 2012, 265(3): 780-789.
9. Yamashita T, Kitao A, Matsui O, et al. Gd-EOB-DTPA-enhanced magnetic resonance imaging and alpha-fetoprotein predict prognosis of early-stage hepatocellular carcinoma. Hepatology, 2014, 60(5): 1674-1685.
10. Shin SK, Kim YS, Shim YS, et al. Peritumoral decreased uptake area of gadoxetic acid enhanced magnetic resonance imaging and tumor recurrence after surgical resection in hepatocellular carcinoma: A STROBE-compliant article. Medicine (Baltimore), 2017, 96(33): e7761.
11. Asayama Y, Tajima T, Nishie A, et al. Uptake of Gd-EOB-DTPA by hepatocellular carcinoma: radiologic-pathologic correlation with special reference to bile production. Eur J Radiol, 2011, 80(3): e243-e248.
12. Korean Society of Abdominal Radiology. Diagnosis of hepatocellular carcinoma with gadoxetic acid-enhanced MRI: 2016 Consensus Recommendations of the Korean Society of Abdominal Radiology. Korean J Radiol, 2017, 18(3): 427-443.
13. Kim SH, Kim SH, Lee J, et al. Gadoxetic acid-enhanced MRI versus triple-phase MDCT for the preoperative detection of hepatocellular carcinoma. AJR Am J Roentgenol, 2009, 192(6): 1675-1681.
14. Hwang J, Kim SH, Lee MW, et al. Small (≤2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of gadoxetic acid-enhanced 3.0 T MRI and multiphasic 64-multirow detector CT. Br J Radiol, 2012, 85(1015): e314-e322.
15. Kim HD, Lim YS, Han S, et al. Evaluation of early-stage hepatocellular carcinoma by magnetic resonance imaging with gadoxetic acid detects additional lesions and increases overall survival. Gastroenterology, 2015, 148(7): 1371-1382.
16. Yoo SH, Choi JY, Jang JW, et al. Gd-EOB-DTPA-enhanced MRI is better than MDCT in decision making of curative treatment for hepatocellular carcinoma. Ann Surg Oncol, 2013, 20(9): 2893-2900.
17. Choi JY, Kim MJ, Park YN, et al. Gadoxetate disodium-enhanced hepatobiliary phase MRI of hepatocellular carcinoma: correlation with histological characteristics. AJR Am J Roentgenol, 2011, 197(2): 399-405.
18. Fujita N, Nishie A, Kubo Y, et al. Hepatocellular carcinoma: clinical significance of signal heterogeneity in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging. Eur Radiol, 2015, 25(1): 211-220.
19. Kiryu S, Akai H, Nojima M, et al. Impact of hepatocellular carcinoma heterogeneity on computed tomography as a prognostic indicator. Sci Rep, 2017, 7(1): 12689.
20. de Lope CR, Tremosini S, Forner A, et al. Management of HCC. J Hepatol, 2012, 56 Suppl 1: S75-S87.
21. Ruà S, Comino A, Fruttero A, et al. Flow cytometric DNA analysis of cirrhotic liver cells in patients with hepatocellular carcinoma can provide a new prognostic factor. Cancer, 1996, 78(6): 1195-1202.
22. Duseja A. Staging of hepatocellular carcinoma. J Clin Exp Hepatol, 2014, 4(Suppl 3): S74-S79.
23. Huppertz A, Haraida S, Kraus A, et al. Enhancement of focal liver lesions at gadoxetic acid-enhanced MR imaging: correlation with histopathologic findings and spiral CT—initial observations. Radiology, 2005, 234(2): 468-478.
24. 刘曦娇, 唐鹤菡, 张笑, 等. 钆塞酸二钠增强 MRI 肝胆期信号与肝细胞肝癌分化程度的关系. 中国普外基础与临床杂志, 2014, 21(12): 1583-1586.
25. Nanashima A, Abo T, Tobinaga S, et al. Relationship between period of survival and clinicopathological characteristics in patients with hepatocellular carcinoma who underwent hepatectomy. Hepatogastroenterology, 2010, 57(99-100): 540-546.
26. Miyaaki H, Nakashima O, Kurogi M, et al. Lens culinaris agglutinin-reactive alpha-fetoprotein and protein induced by vitamin K absence II are potential indicators of a poor prognosis: a histopathological study of surgically resected hepatocellular carcinoma. J Gastroenterol, 2007, 42(12): 962-968.